4 ms·

No doubt there is interesting data to be mined here, but I wouldn't rely on it solely. The vast majority of patients are not in a good position to evaluate the

No doubt there is interesting data to be mined here, but I wouldn't rely on it solely. The vast majority of patients are not in a good position to evaluate the quality of care they received. The kind of things they typically judge by are often fairly superficial attributes: * did I have a long wait time? * was the office staff polite and helpful? * was my physician/NP/PA polite and helpful? * were there billing problems after the appointment? These things do matter, but there are more important factors in play that patients are not in a position to judge: * were standards of care followed by the provider? * were unnecessary tests ordered or unnecessary drugs proscribed? * were necessary tests skipped or necessary drugs not proscribed? * if they had access to my medical history, did the provider bother to review it before seeing me * etc, etc. Quality of care can absolutely be evaluated, and that's happening more and more, it's just that patient satisfaction is only one small part of the whole picture.

mc32 11y ago
Yeah, that's a big problem with democratization of these kinds of things. It's hard for me as a layperson to judge the the talent a specialized professional. All I'd be able to judge are the softer qualities. The things which actually matter like total cost and effectiveness of treatment, etc. Are hard for a single person to judge -teams would have to study and compare data, rather than feelings. So what we can end up getting, if this how doctors get reviewed, is them acting more as feel good doctors, than actual physicians giving you hard advice.
namewithhe1d 11y ago
True, but Dr. Offices are a business. And in smaller offices, the Dr. is the Owner/Manager. Frankly, for the vast majority of Dr. visits, you're there for routine or minor care, and a badly run business will simply keep me away. I don't care how good a chef at a restaurant is, if it takes me 2 hours to order and wait for food, the silverware is dirty, and the surroundings are miserable, I'm never coming back.
- tptacek 11y ago
  The concern is that increased attention to superficial details will advantage poorer doctors who are better at customer service, which isn't a win for consumers. Already in this story you see the effect of massage therapists being statistically advantaged over internal medicine doctors. That's obviously silly, but the same effect happens within the medical profession, between different doctors.
  - namewithhe1d 11y ago
    It's true in the short run, though it will also place a much higher value on those doctors that are good at what they do, and run a good business. And those are the offices that will benefit the best in the long run. /endrant
    - tptacek 11y ago
      At the very top tier, the most advantaged professionals will be those doctors who are fundamentally effective and apt at customer service. Surfacing them is a win for consumers. But the next tier after that will be a raft of professionals who are not necessarily effective, but still apt at customer service. Elevating them is a loss for consumers. The question you then want to ask is, is it harder to be good at customer service, or harder to be good at internal medicine? I think customer service is easier, and thus worry that the second tier will be the largest of the tiers. An easy response to this is to say that doctors will learn to get better at customer service. Maybe. But the effect I'm talking about also happens if we stipulate that none of these professionals really change at all, and instead the market just changes the way we sort them. I think that is likelier than the scenario where doctors who are not simultaneously good at medicine and managing an office suddenly figure out customer service.
- timtadh 11y ago
  Small single practices office are going away. Doctors are corporatizing either by merging with other practices or being bought out by hospitals or hospital groups. The reason: electronic medical records and new regulatory requirements. The burden of these regulations has been making it increasingly costly to run single doctor practices. So the result is less choice (in business) and less control for the doctor over the patient experience. In conclusion, it is a nice idea to think of the doctors as "business people" but the reality is there are fewer and fewer who are. Most are now employees in a large corporate system. (also +1 to the sibling comments)

mc32 11y ago

Yeah, that's a big problem with democratization of these kinds of things. It's hard for me as a layperson to judge the the talent a specialized professional. All I'd be able to judge are the softer qualities. The things which actually matter like total cost and effectiveness of treatment, etc. Are hard for a single person to judge -teams would have to study and compare data, rather than feelings. So what we can end up getting, if this how doctors get reviewed, is them acting more as feel good doctors, than actual physicians giving you hard advice.

namewithhe1d 11y ago

True, but Dr. Offices are a business. And in smaller offices, the Dr. is the Owner/Manager. Frankly, for the vast majority of Dr. visits, you're there for routine or minor care, and a badly run business will simply keep me away. I don't care how good a chef at a restaurant is, if it takes me 2 hours to order and wait for food, the silverware is dirty, and the surroundings are miserable, I'm never coming back.

tptacek 11y ago
The concern is that increased attention to superficial details will advantage poorer doctors who are better at customer service, which isn't a win for consumers. Already in this story you see the effect of massage therapists being statistically advantaged over internal medicine doctors. That's obviously silly, but the same effect happens within the medical profession, between different doctors.
- namewithhe1d 11y ago
  It's true in the short run, though it will also place a much higher value on those doctors that are good at what they do, and run a good business. And those are the offices that will benefit the best in the long run. /endrant
  - tptacek 11y ago
    At the very top tier, the most advantaged professionals will be those doctors who are fundamentally effective and apt at customer service. Surfacing them is a win for consumers. But the next tier after that will be a raft of professionals who are not necessarily effective, but still apt at customer service. Elevating them is a loss for consumers. The question you then want to ask is, is it harder to be good at customer service, or harder to be good at internal medicine? I think customer service is easier, and thus worry that the second tier will be the largest of the tiers. An easy response to this is to say that doctors will learn to get better at customer service. Maybe. But the effect I'm talking about also happens if we stipulate that none of these professionals really change at all, and instead the market just changes the way we sort them. I think that is likelier than the scenario where doctors who are not simultaneously good at medicine and managing an office suddenly figure out customer service.
timtadh 11y ago
Small single practices office are going away. Doctors are corporatizing either by merging with other practices or being bought out by hospitals or hospital groups. The reason: electronic medical records and new regulatory requirements. The burden of these regulations has been making it increasingly costly to run single doctor practices. So the result is less choice (in business) and less control for the doctor over the patient experience. In conclusion, it is a nice idea to think of the doctors as "business people" but the reality is there are fewer and fewer who are. Most are now employees in a large corporate system. (also +1 to the sibling comments)